It's a simple fact of life that even the best lessons are sometimes forgotten or get lost in the bustle of everyday living. That's especially true with a condition as complicated as diabetes: Even when people remember what their doctors tell them, there are a host of forces that get in the way of implementing the advice. "Many people struggle with following all the recommendations and maintaining [blood glucose] at targeted levels," says Katie Weinger, EdD, RN, FAADE, a researcher at the Joslin Diabetes Center.

In a landmark national study of intensive blood glucose control in people with type 1 diabetes, for example, fewer than half of the participants managed to get their A1C levels (average blood glucose over two to three months) close to 6 percent at any point, and only 5 percent were able to maintain that level throughout the study.

It's not necessarily that there's anything wrong with the diabetes education people are getting. But with funding for follow-up so limited—Medicare pays for 10 hours of diabetes education when people are first diagnosed, and two hours per year after that, for example—it's often hard to reinforce what patients are told in a lasting way. "One dose of education doesn't last a lifetime, just like a dose of medicine doesn't last forever," Weinger says. "Without structure and support, people slip up: Life is busy, and all this can be overwhelming."

One tool that may help is called a Conversation Map. Inspired by tools used in business seminars, the maps were first introduced by Canadian diabetes educators in 2005, and have been promoted since 2007 by the American Diabetes Association as a visual tool used by educators to make talking about health issues easier. The maps are colorful, cartoon-like depictions of street scenes, much like large board games. A hot air balloon in the sky represents glucose levels sailing too high or sinking too low, while a "no U-turn" sign in the road is a launching point for discussions about the chronic, lifelong nature of caring for diabetes.

Created by the Chicago-based company Healthy Interactions, the maps now come in hundreds of designs aimed at different groups, including other medical conditions in addition to diabetes, and have been produced in dozens of languages. There are maps made specifically for people who have just been diagnosed with type 2 diabetes, for example, and different sets of maps for African Americans, people with gestational diabetes, and families struggling to cope with type 1 diabetes.

The idea is to use the maps to start a conversation about dealing with diabetes among people sitting around the table. Typically, a trained diabetes educator works with three to 10 people at once, guiding a discussion about key topics. The maps are supposed to help people retain information by incorporating a visual element. "Even the Egyptians used pictures to help teach people. The principle has been around for centuries," says Healthy Interactions cofounder Paul Lasiuk. "Diabetes is a very complicated topic, and we want to lower as many barriers as possible."

As popular as the maps have been, Weinger says, there's as yet been no scientific evidence as to how effective the maps really are. With the help of a grant from the ADA, Weinger is working with people who have already had at least three hours of diabetes education in the past but are still struggling with their A1C levels. Half of the participants—the control group—are enrolled in four hours of traditional classes on heart-healthy living, a subject that's useful but doesn't have anything directly to do with diabetes. The other half receive four one-hour group sessions with a diabetes educator, using the Conversation Maps. Participants in both groups are then monitored over the course of a year to see whether there's an improvement in their A1C levels.

Weinger's goal is to see whether the Conversation Maps are a good way to reinforce what people already know about dealing with diabetes. If the group using the maps shows tighter blood glucose control, it's a good sign that the maps are reinforcing what people have been told by doctors or diabetes educators in a way that sticks. The knowledge will help diabetes educators do a better job of helping patients help themselves. "If you have limited education resources, you want to make sure that what you're using is effective," Weinger says. "Reinforcement is necessary, and we're trying to figure out the best way."

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